Winging of scapula ?

Winging of scapula ?

what is winging of scapula – also known as scapular winging

Is a condition characterize by the protrusion or abnormal movement of the scapula (shoulder blade) away from the back of the rib cage.

Normally the scapula lies flat against the rib cage, providing stability and facilitating the movement of the shoulder joint.

However in cases of scapular winging the scapula sticks out or moves excessively causing functional limitations and discomfort.

Causes

1. Nerve damage: The most common cause of scapular winging is damage or dysfunction of the long thoracic nerve, which controls the muscles that stabilize the scapula. This nerve can be injured due to trauma, compression, or repetitive overuse, such as in sports or certain occupations.
2. Muscle weakness or imbalances: Weakness or imbalances in the muscles around the scapula, particularly the serratus anterior, can lead to scapular winging. This can occur due to muscle atrophy, nerve damage, or inadequate muscle activation.
3. Trauma or injury: Direct trauma to the scapula or surrounding structures can result in scapular winging. Fractures or dislocations of the shoulder or scapula can disrupt the normal alignment and function of the scapula.
4. Muscular disorders: Certain neuromuscular conditions, such as muscular dystrophy or myopathy, can affect the muscles responsible for scapular stabilization and contribute to scapular winging.

Symptoms

• Visible protrusion or abnormal movement of the scapula when moving the arm or pushing against resistance.
• Weakness or difficulty with overhead activities, pushing, or pulling.
• Shoulder or upper back pain.
• Limited range of motion in the shoulder.
• Fatigue or discomfort with prolonged shoulder use.

Diagnosis of winging of scapula ?

The diagnosis of scapular winging typically involves a comprehensive evaluation by a healthcare professional such as an orthopedic specialist or a physical therapist.

The process may include the following steps:

Medical history:

The onset of winging, any relevant medical conditions, previous injuries and activities that may contribute to the problem.

Physical examination:

The healthcare professional will physically examine your shoulder and scapula, looking for signs of winging and assessing the range of motion, strength and stability of the shoulder joint.

They may ask you to perform certain movements and resistances to evaluate the function of the scapular stabilizing muscles.

Muscle testing:

The strength and function of the muscles around the scapula, particularly the serratus anterior muscle will be assess through manual muscle testing.

Weakness or imbalance in these muscles can contribute to scapular winging.

Nerve assessment:

If nerve damage is suspected as the underlying cause of scapular winging.

The healthcare professional may perform additional tests to evaluate the function of the nerves in the shoulder region.

This may include nerve conduction studies or electromyography (EMG) to assess the electrical activity of the muscles and nerves.

Imaging studies:

In some cases imaging studies may be advice to further evaluate the structures around the scapula and rule out other potential causes of winging.

X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be use to assess bony structures, soft tissues and the overall alignment of the shoulder joint.

Based on the findings from the medical history, physical examination and any necessary imaging studies.

The healthcare professional can make a diagnosis of scapular winging and determine the underlying cause.

This information will guide the development of an appropriate treatment plan tailored to your specific condition and needs.

Physiotherapy Treatment winging of scapula ?

Physiotherapy plays a crucial role in the treatment of scapular winging.

The primary goals of physiotherapy are to improve scapular stability, strengthen the surrounding muscles, correct muscle imbalances, and restore normal shoulder function.

The specific treatment plan may vary depending on the underlying cause and severity of the winging.

Here are some common physiotherapy interventions for scapular winging:

Muscle strengthening exercises:

Physiotherapists will prescribe exercises to target the muscles involved in scapular stabilization, particularly the serratus anterior, rhomboids and trapezius muscles.

These exercises may include scapular protraction and retraction exercises, shoulder blade squeezes, wall push-ups, and shoulder strengthening exercises using resistance bands or weights.

Range of motion exercises:

Gentle stretching exercises may be advice to improve the flexibility and mobility of the shoulder joint.

These exercises may target the chest muscles (pectoralis major and minor), posterior shoulder muscles and the muscles around the neck and upper back.

Scapular retraining:

Physiotherapists may use specific techniques to help retrain and reeducate the muscles around the scapula for improved stability and control.

This may involve exercises focusing on scapular control and proper movement patterns during functional activities.

Posture correction:

Poor posture can contribute to scapular winging.

Physiotherapists can provide guidance on maintaining correct posture, both during activities and at rest

To reduce excessive stress on the shoulder and scapular muscles.

Modalities and manual therapy:

Depending on the individual’s needs, physiotherapists may incorporate modalities

such as heat or cold therapy, ultrasound, electrical stimulation or soft tissue mobilization

To relieve pain, reduce muscle tightness and improve tissue healing.

Activity modification and ergonomic advice:

Physiotherapists can provide guidance on modifying activities and workplace ergonomics to prevent further aggravation and support optimal scapular function.

Home exercise program:

To ensure the continuity of the rehabilitation process, a personalized home exercise program will be prescribed.

This program will include exercises and stretches to be performed independently to enhance strength, flexibility, and functional recovery.

It is essential to consult with a qualified physiotherapist who specializes in shoulder and scapular rehabilitation

To receive an accurate assessment and personalized treatment plan based on your specific needs.

They will guide you through the appropriate exercises and monitor your progress to help you regain optimal shoulder function and reduce scapular winging.